经口内镜甲状腺切除术前庭入路并术中神经监测
Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring.
作者信息
Inabnet William B, Suh Hyun, Fernandez-Ranvier Gustavo
机构信息
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Surgery, Mount Sinai Beth Israel, First Ave at 16th St, Baird Hall, 16th Floor, Suite 20, New York, NY, 10003, USA.
出版信息
Surg Endosc. 2017 Jul;31(7):3030. doi: 10.1007/s00464-016-5322-y. Epub 2016 Nov 10.
BACKGROUND
Transoral endoscopic thyroidectomy by a vestibular approach (TOETVA) is a novel technique for thyroid gland excision. Compared to the transaxillary endoscopic and bilateral axillo-breast approaches, which require substantial dissection to reach the thyroid gland, TOETVA provides the most direct access to the target organ.
METHODS
The aim of this video is to provide a step-by-step overview of TOETVA and demonstrate how to set up and utilize intraoperative nerve monitoring.
RESULTS
Three incisions are placed in the vestibular region of the oral cavity just below the lower lip for placement of 2 lateral 5-mm trocars and 1 centrally placed 11-mm trocar. Insufflation to 6 mm Hg is used to maintain the working spacing. Using a 2-handed technique and triangulation, the thyroid gland is mobilized, taking care to identify and preserve the relevant cervical anatomy.
CONCLUSION
TOETVA is safe and feasible and provides an excellent cosmetic outcome with the most confidentially compared to the other remote access endoscopic approaches.
背景
经口前庭入路内镜甲状腺切除术（TOETVA）是一种新型的甲状腺切除技术。与经腋窝内镜手术和双侧腋窝-乳房入路相比，后两者需要大量解剖才能到达甲状腺，而TOETVA能最直接地到达目标器官。
方法
本视频的目的是逐步概述TOETVA，并演示如何设置和使用术中神经监测。
结果
在口腔前庭区域下唇下方做三个切口，用于置入2个外侧5毫米套管针和1个位于中央的11毫米套管针。使用6毫米汞柱的气腹压力来维持操作空间。采用双手技术和三角定位法，游离甲状腺，注意识别和保留相关的颈部解剖结构。
结论
TOETVA安全可行，与其他远程入路内镜手术相比，能提供极佳的美容效果，且具有最高的隐蔽性。
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